22-Year-Old Female: Post-EBV Infection with Autoimmune Concerns
**Demographics:** 22 years old, Female **Region:** United States **Health Background:** Diagnosed with Epstein-Barr Virus (mononucleosis) in April 2025, though symptoms first emerged on February 14, 2025, leading to a two-month delay in diagnosis. **Primary Issue:** Experiencing ongoing, diverse symptoms and irregular autoimmune test results for six months since the EBV infection. These issues significantly diminish daily life and seem to be progressively worsening. **Current Symptoms Include:** * **Extreme fatigue** lasting since February * **Joint pain** that shifts locations * **Constipation** * **Bloating** accompanied by tightness in abdominal muscles (above the navel) * **Tightness in mid-back muscles** * **General discomfort throughout the torso** * **Minor dizziness** * **Severely chapped lips** with cracks at the corners (indicative of angular cheilitis) * **Burning sensation** in the nasal passages * **Inward suctioning of nostrils** during inhalation, producing a whistling sound * **Sensitivity to light**, with heightened brightness and occasional dark or color spots in vision * **Urinary discomfort**: burning sensation during urination, frequent urgency, and general discomfort * **Eczema flare-ups** * **New irritation on a finger** (dry and red rash) * **Feeling of tightness while breathing**, akin to "breathing through a straw" **Laboratory Findings (February - July 2025):** * **EBV VCA IgM:** Positive results in March and July * **EBV VCA IgG & EBNA IgG:** High levels detected * **Antinuclear Antibody (ANA):** Positive result of 1:80, speckled pattern (July) * **Anti-Thyroid Peroxidase (Anti-TPO) antibodies:** Elevated levels (suggesting possible thyroid autoimmune condition) * **Ferritin levels:** Fluctuating but consistently high (187 ng/mL to 134 ng/mL back to 193 ng/mL) * **Vitamin D levels:** Changes from 12.4 ng/mL to 45.3 ng/mL then drops to 36.2 ng/mL * **Vitamin B12 levels:** Notably elevated * **Thyroid indicators (TSH & Free T4):** Within normal limits, yet Anti-TPO remains high * **ALT:** Initially high in February, later normalized * **Urinalysis in February:** Showed presence of red blood cells, protein, and ketones with later normalization * **Lyme Disease test:** Negative results *Is it possible that these symptoms are indicative of post-viral syndrome leading to autoimmune disorders such as Hashimoto’s, Sjögren’s syndrome, lupus, or connective tissue diseases?* *What further tests or specialist referrals should I pursue in light of my symptoms and lab results?*
Answers (1)
8/10/2025, 10:10:57 PM
OpenHealth AI
It sounds like you have been experiencing a complex array of symptoms since your Epstein-Barr Virus (EBV) infection, leading to significant concerns about potential autoimmune disorders. Your symptoms and lab results indicate a possibility of post-viral syndrome and may indeed raise concerns about autoimmune conditions. It's important to address your immediate symptoms and gather further information about your health to clarify your diagnosis.
Explanation
Many individuals who recover from EBV develop lingering symptoms, including fatigue and joint pain, which can mimic or precede autoimmune disorders. The presence of elevated Anti-TPO antibodies in your lab results suggests a possible thyroid issue, such as Hashimoto's thyroiditis. Your positive ANA could also indicate an autoimmune process but isn't specific to one condition.
Given the diverse nature of your symptoms—ranging from fatigue and joint pain to gastrointestinal issues and dermatological concerns—this suggests the need for a comprehensive approach to manage and evaluate your health.
Next Steps
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Symptom Management:
- Focus on maintaining a balanced diet with adequate hydration to alleviate some gastrointestinal symptoms like constipation and bloating.
- Consider incorporating anti-inflammatory foods (e.g., fatty fish, nuts, and leafy greens) to help with joint and muscle discomfort.
- Ensure good sleep hygiene to improve fatigue: aim for regular sleep hours, a soothing nighttime routine, and a comfortable sleep environment.
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Referral to Specialists:
- Rheumatologist: To evaluate your autoimmune markers and symptoms further. They can help determine if you have conditions like lupus, Sjögren's syndrome, or other connective tissue diseases.
- Endocrinologist: To assess your thyroid function in detail, given the elevated Anti-TPO and your concerns regarding possible thyroid-related autoimmune issues.
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Further Testing:
- Comprehensive Metabolic Panel and Complete Blood Count (CBC): To monitor overall health and any potential underlying abnormalities.
- Thyroid Function Tests (T3, T4, and TSH): To get a clearer picture of your thyroid health.
- Specific Autoimmune Panels: Depending on specialist recommendations, tests for other autoimmune markers may be warranted to clarify your condition.
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Keep a Symptom Journal:
- Track your symptoms daily, noting their severity, triggers, and any correlating factors. This can provide valuable insights for your healthcare providers.
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Mental Health Support:
- Given the impact of chronic symptoms on daily life, consider talking with a mental health professional. Chronic illness can lead to feelings of frustration or anxiety, and support can assist in coping strategies.
By taking these steps, you will be actively managing your health and gathering important information to guide your healthcare decisions. If your symptoms worsen or new symptoms arise, please seek immediate healthcare advice. Remember, it’s essential to listen to your body and prioritize your well-being as you navigate this complex situation.
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7 Months Old) - **Weight:** 9 kg (good growth rate in spite of condition) - **Jaundice:** Continues to be present (yellow skin) - **Stools:** Remain pale/clay-colored - **Development:** Achieving appropriate milestones - **Energy:** Appears to have a good energy level - **Feeding:** Normal appetite --- ## QUESTIONS FOR r/AskDocs We have been informed this is **Type 2 Abernethy malformation** (portal vein present). **Three treatment avenues have been proposed:** ### Option 1: **Endovascular Coil Embolization** (minimally invasive approach) - A catheter is inserted via the leg vein to access the shunt and deploy coils/plugs to close the abnormal vessels - Pros: No surgical incision, minimal discomfort, short hospital stay (2-4 days), no scars, enhanced safety - Duration: 1-2 hours - Recovery: 2-4 weeks for jaundice to show improvement ### Option 2: **Open Surgical Intervention** - An incision in the abdomen to ligate abnormal vessels and redirect blood to the liver - Pros: Direct visualization, effective results - Cons: Surgical scar, longer recovery time (7-14 days in hospital) - Duration: 2-4 hours ### Option 3: **Liver Transplantation** - We have been advised this is not necessary as the portal vein is functional and liver health is improving. --- ## SPECIFIC QUESTIONS TO CONSIDER: 1. **With a functional portal vein (6.1 mm) and improving liver function (ALT normalized), is it advisable to pursue endovascular closure as the preferred treatment?** 2. **Despite ALT levels improving, the bilirubin remains consistently high (242). Should this be a cause for concern? Is there a prospect for it to normalize post shunt closure?** 3. **Are the hemangiomas/nodules (11.6×20.7 mm) linked to the shunt? Will they likely resolve following shunt repair?** 4. **How urgent is the proposed intervention? Is immediate action required, or is there flexibility to wait a few months?** 5. **What complications should we be vigilant for during the waiting period?** 6. **Regarding endovascular closure - what is the average success rate for infants aged 7 months? Are there concerns regarding the shunt size (9.9 mm)?** 7. **The measurement of the portal vein has shown improvement from 6.1 mm to 3.9 mm; should this be perceived as a positive sign or a reason for concern?** 8. **Are there special directives (diet modifications, medications) we should consider while awaiting the procedure?** 9. **Post-procedure, how long should we expect it might take for:** - Normalization of bilirubin levels? - Return of stool color to normal? - Resolution of jaundice? - Regression of hemangiomas? 10. **Can you recommend any specialized centers for pediatric Abernethy malformation treatments? We are located in Uzbekistan but are prepared to travel (to Turkey, Russia, South Korea, etc.)** --- ## ADDITIONAL INFORMATION - No family history of hepatic diseases - Pregnancy and delivery were normal - No additional congenital defects identified - Immunizations up to date - No history of bleeding disorders - No signs indicative of encephalopathy - Child is alert and engaged --- **I can supply actual MSCT images and comprehensive lab reports if they would be of assistance.** We sincerely appreciate any insights you can provide. We are striving to make the most informed decision regarding our daughter’s care and highly value expert medical opinions. **TL;DR:** 7-month-old diagnosed with Abernethy Type 2 malformation (9.9 mm portocaval shunt, patent portal vein). Liver functionality is improving (normalized ALT) while bilirubin remains elevated (242). Evaluating options between endovascular coil embolization and open surgery. Seeking expert advice on optimal treatment strategy and timing.